Information Collection

Physicians

IC 249960 under ICR 202203-1557-005 · OMB 1557-0352.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Physicians	Form
Medical Exception to COVID Vaccination Requirement Medical Exception to COVID Vaccination Requirement OCC Fillable Form Oct 2021.pdf	Form
Medical Exception to COVID Vaccination Requirement Medical Exception to COVID Vaccination Requirement OCC Fillable Form Oct 2021.pdf	Form

IC Title:

Physicians

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	N/A	Medical Exception to COVID Vaccination Requirement	Medical Exception to COVID Vaccination Requirement OCC Fillable Form Oct 2021.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 66

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	66	66
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.